The Long Haul

How do you help a client who has been the recipient of case management supports for 14 years, and does not yet understand why she is receiving the service and what is its purpose? She can tell me exactly the number of visits she’s had (108 from me over the past 2.5 years, 784 total from all CM’s) but not why they are happening.

Careful of becoming frustrated, I go into empathetic mode. “You seem to have some questions…” “I hear that this is distressing you…” “Is there help you would like that you don’t feel you are getting…”

I’m not sure she hears what I say, as she would like to reinforce her previous statements, and repeats what she’s said before I am finished. Then repeats it again. We are testing the limits of the “recovery model” profoundly here.

So I call in the reinforcements. Her “natural supports” (dad) to keep him in the loop. He really wants to help, but doesn’t always know how. The “formal supports” (housing provider) to give a heads up and some background on the angry and frustrated phone call(s) they will inevitably be receiving. My supervisor so I can check my feelings about the situation, and get the help I need to figure out clinical solutions that may work here.

I really do believe in recovery. A situation like this makes me wonder if there was a failure in the system along the way, something early on perhaps that did not help this person gain understanding and a sense of control over their life situation (answer=probably). Perhaps it’s the set up, the fact that by accepting a rent supplement, she is bound to the “support” aspect of supportive housing. This policy has always troubled me as it is so far from “recovery” based.

On the other hand, maybe this is what recovery looks like for her. She’s been able to live in a place she likes for all those years. She has hobbies and things she likes to do, however sporadically she does them. She tells me she never wants to return to work, and does not want anything drastically different in her life.

Or instead, that could mean we haven’t done a good enough job of instilling hope and conveying a sense of what is possible.

Perhaps her journey is just a painstakingly slow long one. Maybe 14 years has just not been enough to create a new sense of self and new way of living after (what I understand to be) many years of neglect, abuse, illness and loss.

Sometimes it is just too hard to know.